Body mass index of adults with intellectual disability participating in Special Olympics by world region

Effects of exercise on body mass index and waist circumference of individuals with intellectual and developmental disabilities: a systematic review with meta-analysis

Introduction/Methods: This systematic review with meta-analysis aims to assess the magnitude of the effects of physical exercise programs on body mass index (BMI) and waist circumference (WC) of individuals with Intellectual and Developmental Disabilities (IDD), metabolic and cardiovascular health markers. Results: Considering the eligibility criteria, a final sample of nine articles was obtained. For BMI, the Z-value obtained to test the null hypothesis (difference between means is zero), showed a Z = -2.176 and p = 0.03. The highest magnitude of the effect was from the intervention with combined training (difference in means: -0.399), with a value of Z = -1.815 and p = 0.07. For WC, the Z-value is zero, showing a Z = -3.306 and p = 0.001. The highest magnitude of the effect was from the intervention with continuous cardiorespiratory training of -0.786, with a value of Z = -2.793 and p = 0.005. Discussion: Physical exercise prevents increases in BMI and WC in individuals with IDD. Aerobic training seems to be more effective in promoting WC and combined training in BMI. Systematic Review Registration: [PROSPERO], identifier [CRD42021255316].

Low Muscle Strength, Low Bone Mineral Density, and High Body Mass Index Among Adult Special Olympics Athletes: A Cross-Sectional Examination

Adults with intellectual disabilities have increasing life expectancy but may be susceptible to early aging-related conditions. The purpose of this study was to examine associations between the presence of low muscle strength, low bone mineral density, and high body mass index with age and sex in adult Special Olympics athletes. Grip strength (n = 6,477; 40.9% female), chair stand time (n = 6,444; 40.5% female), body mass index (n = 7,824; 43.7% female), and bone mineral density (n = 3,091; 43.2% female) measurements were provided by Special Olympics International. Poor grip strength, chair stand time, bone mineral density, and body mass index were identified in 43.8%, 46.2%, 28.7%, and 50.3% of each sample, respectively. Increasing age was a risk factor for all conditions (odds ratio = 1.30-10.89; p < .05). High rates of adverse health conditions were observed in a sample of adults with intellectual disabilities. Increased risk was observed as early as the fourth decade of life.

The Top 50 Most Cited Articles on Special Olympics: A Bibliometric Analysis

The Special Olympics was established in 1968 to "provide year-round sports training and athletic competition in a variety of Olympic-type sports for children and adults with intellectual disabilities". It has gained recognition in the field of sports and healthcare of persons with intellectual disability, with a large number of dedicated researchers and institutions all over the world. However, there is an urgent need to analyze the progress and current status of this research field to identify knowledge gaps and develop this discipline. The aim of this study was to analyze the scientific production of the Special Olympics and report the bibliometric characteristics of the top 50 most cited Special Olympics publications. A systematic search was conducted on the Scopus database and bibliometric data were extracted and analyzed. The top 50 publications received 1632 citations. A total of 138 authors (63 female and 75 male) contributed to these publications. The two main areas of study were the physical health of Special Olympics athletes (n = 27) and the psycho-social health of athletes (n = 12).

Sedentary Time, Physical Activity Levels and Physical Fitness in Adults with Intellectual Disabilities

Purpose: This cross-sectional study assessed the associations of gender, age, level of intellectual disabilities (IDs) and of daily sedentary and physical activity (PA) time with physical fitness in adults with ID. Materials and methods: Sixty adults (mean age = 39.19 ± 11.70 years) with ID participated in this cross-sectional study. PA was monitored for 7 days using an ActiGraph GT3X monitor. Physical fitness was measured with a 6-min walking test, isometric push-up test, modified curl-up test, handgrip strength test, and back-saver sit-and-reach test. Results: (a) An age of ≥39 years and female gender were associated with lower performance in multiple aspects of physical fitness. (b) More moderate-to-vigorous PA (MVPA) was associated with greater muscular strength and endurance (modified curl-ups: β = 0.36, p < 0.01; handgrip strength: right, β = 0.52, p < 0.01; left, β = 0.52, p < 0.01). (c) More light-intensity PA (LPA) was associated with greater upper-body muscular endurance (β = 0.42, p < 0.01) and greater flexibility (right leg: β = 0.36, p < 0.01; left leg: β = 0.38, p < 0.01). Conclusion: LPA may be as beneficial as MVPA to the physical fitness of adults with ID. Future studies should focus on developing effective PA interventions for adults with ID, especially for women and individuals aged ≥39 years, by incorporating both LPA and MVPA.

Patterns in the prevalence of diabetes and incidence of diabetic complications in people with and without an intellectual disability in Dutch primary care: Insights from a population-based data-linkage study

AIMS

To conduct an epidemiological analysis of patterns observed in diabetes care provided to individuals with and without intellectual disabilities (ID) in primary care settings.

METHODS

An ID-cohort (N = 21,203) was compared with a control group of similar age and sex from the general Dutch population (N = 267,628). Distinctive data for diabetes (both type 1 and type 2) and related complications were retrieved from national databases.

RESULTS

The prevalence of diabetes was higher in people with ID than in the general population (9.9% versus 6.6%). Largest differences were seen in younger age groups. Women with ID had diabetes more often than men with ID. Complications were less common in people with ID than in the general population (IR 58.6 vs. 70.4). In particular, cardiological complications were noted less, while surgical interventions and hospitalization occurred more often.

CONCLUSIONS

Although diabetes was 1.5 times more prevalent in people with ID than in other people, related complications were less common, followed different patterns and were more severe than in the general population. Future research is needed to understand of the underlying causal mechanisms and to lower the risk of severe diabetic complications among people with ID.

Weight status and associated comorbidities in children and adults with Down syndrome, autism spectrum disorder and intellectual and developmental disabilities

BACKGROUND

Little is known about body weight status and the association between body weight and common comorbidities in children and adults with Down syndrome (DS), autism spectrum disorder (ASD) and other intellectual and developmental disabilities (IDDs).

METHODS

Data were extracted from the University of Kansas Medical Center's Healthcare Enterprise Repository for Ontological Narration clinical integrated data repository. Measures included demographics (sex, age and race), disability diagnosis, comorbid health conditions, height, weight and body mass index percentiles (BMI%ile; <18 years of age) or BMI (≥18 years of age).

RESULTS

Four hundred and sixty-eight individuals with DS (122 children and 346 adults), 1659 individuals with ASD (1073 children and 585 adults) and 604 individuals with other IDDs (152 children and 452 adults) were identified. A total of 47.0% (DS), 41.9% (ASD) and 33.5% (IDD) of children had overweight/obese (OW/OB), respectively. Children with DS were more likely to have OW/OB compared with children with IDD or ASD [odds ratio (OR) = 1.91, 95% confidence interval (CI): (1.49, 2.46); OR = 1.43, 95% CI: (1.19, 1.72)], respectively. A total of 81.1% (DS), 62.1% (ASD), and 62.4% (IDD) of adults were OW/OB, respectively. Adults with DS were more likely to have OW/OB compared with those with IDD [OR = 2.56, 95% CI: (2.16, 3.02)]. No significant differences were observed by race. In children with ASD, higher OW/OB was associated with significantly higher (compared with non-OW/OB) occurrence of sleep apnoea [OR = 2.94, 95% CI: (2.22, 3.89)], hypothyroidism [OR = 3.14, 95% CI: (2.17, 4.25)] and hypertension [OR = 4.11, 95% CI: (3.05, 5.54)]. In adults with DS, OW/OB was significantly associated with higher risk of sleep apnoea and type 2 diabetes [OR = 2.93, 95% CI: (2.10, 4.09); OR = 1.76, 95% CI: (1.11, 2.79) respectively]. Similarly, in adults with ASD and IDD, OW/OB was significantly associated with higher risk of sleep apnoea [OR = 3.39, 95% CI: (2.37, 4.85) and OR = 6.69, 95% CI: (4.43, 10.10)], type 2 diabetes [OR = 2.25, 95 % CI: (1.68, 3.01) and OR = 5.49, 95% CI: (3.96, 7.61)] and hypertension [OR = 3.55, 95% CI: (2.76, 4.57) and 3.97, 95% CI: (3.17, 4.97)].

CONCLUSION

Findings suggest higher rates of OW/OB in individuals with DS compared with ASD and IDD. Given the increased risk of comorbidities associated with the increased risk of OW/OB, identification of effective interventions for this special population of individuals is critical.

The impact of multicomponent programmes on balance and fall reduction in adults with intellectual disabilities: a randomised trial

BACKGROUND

One challenge a modern society faces is this: providing those vulnerable and ageing groups of adults who have intellectual disabilities with appropriate support for improving static and dynamic balance. Balance is a crucial component of physical fitness and, consequently, of fall reduction and prevention. The aim of the present randomised controlled trial was to evaluate the efficacy, after 16 weeks, that three different Special Olympics physical activity programmes had on balance and on fall reduction in adults with intellectual disabilities.

METHOD

A convenience sample of 150 persons with mild and moderate intellectual disabilities was recruited from the accessible Special Olympics Slovenia population of physically inactive adults with intellectual disabilities. The sample was randomised to the experimental group 1 (multicomponent balance-specific exercise programme group with additional workshops on such social gerontology topics as active and healthy ageing; N = 50), the experimental group 2 (multicomponent wellness programme group; N = 50) and a control group (regular Special Olympics athletic training; N = 50).

RESULTS

Significant differences were found between groups in the balance scores throughout the study period and in the ability to decrease fall frequency.

CONCLUSIONS

Balance assessment is a high predictor of frequency of falls, and among adults with intellectual disabilities, it significantly correlates with exercise. The results indicate that a multicomponent balance-specific exercise programme with a significant sociogerontological component on active ageing could be a useful intervention for intellectually disabled adults who have poor balance and who experience frequent falls.

Prevalence of underweight, wasting and stunting among young children with a significant cognitive delay in 47 low-income and middle-income countries

BACKGROUND

Undernutrition in early childhood is associated with a range of negative outcomes across the lifespan. Little is known about the prevalence of exposure to undernutrition among young children with significant cognitive delay.

METHOD

Secondary analysis of data collected on 161 188 three- and four-year-old children in 47 low-income and middle-income countries in Rounds 4-6 of UNICEF's Multiple Indicator Cluster Surveys. Of these, 12.3% (95% confidence interval 11.8-12.8%) showed evidence of significant cognitive delay.

RESULTS

In both middle-income and low-income countries, significant cognitive delay was associated with an increased prevalence of exposure to three indicators of undernutrition (underweight, wasting and stunting). Overall, children with significant cognitive delay were more than twice as likely than their peers to be exposed to severe underweight, severe wasting and severe stunting. Among children with significant cognitive delay (and after controlling for country economic classification group), relative household wealth was the strongest and most consistent predictor of exposure to undernutrition.

CONCLUSIONS

Given that undernutrition in early childhood is associated with a range of negative outcomes in later life, it is possible that undernutrition in early childhood may play an important role in accounting for health inequalities and inequities experienced by people with significant cognitive delay in low-income and middle-income countries.

Preventing and Treating Diabetes in Canadian Adults With Intellectual and Developmental Disabilities

Despite emerging evidence that individuals with intellectual and developmental disabilities (IDD) have a high prevalence of diabetes, Canada does not have a strategy to address diabetes in this population. The aim of this review was to review effective health policies and practices to improve diabetes prevention and management developed by other jurisdictions in response to the high prevalence of diabetes among individuals with IDD. To do so, a narrative literature review was conducted based on 18 studies, in addition to 3 examples of resources, 2 systematic reviews, the Canadian diabetes guidelines, the UK diabetes guidelines and Kachika's "NHS RightCare Pathway" report. Consistent with the "Diabetes 360°: A Framework for a Diabetes Strategy for Canada" report, findings were summarized under 3 themes: 1) diabetes prevention and health promotion, 2) diabetes screening and 3) diabetes self-management. We also identified 2 additional areas that cut across all 3 of the themes: 1) diabetes health literacy and 2) role of carers in prevention, screening and treatment efforts. Our review identifies strategies to meet the unique needs of people with IDD who have diabetes, in order to encourage Canadian initiatives to address these needs.

Correlates of Sedentary Behaviour in Adults with Intellectual Disabilities-A Systematic Review

Individuals with intellectual disabilities (ID) are at high risk for high levels of sedentary behaviour. To inform the development of programmes to reduce sedentary behaviour, insight into the correlates is needed. Therefore, the aim of this study is to review the evidence on correlates of sedentary behaviour in adults with ID. We performed a systematic literature search in Ovid Medline, Ovid Embase, Web of Science and Google Scholar up to 19 January 2018, resulting in nine included studies that were published from 2011 to 2018. Correlates were categorized according to the ecological model. Studies predominantly focused on individual level correlates. Of those correlates studied in more than one study, having epilepsy was associated with less sedentary behaviour and inconsistent results were found for sex, genetic syndromes, weight status, physical health, mobility, level of ID, and mental health. Of the few interpersonal and environmental factors studied, only living arrangements were studied in more than one study, with inconsistent results. To date, we have limited and inconclusive evidence about correlates of sedentary behaviour in adults with ID. Only when future studies unravel correlates and determinants, across all domains of the ecological model, will the potential opportunities to improve health by reducing sedentary behaviour come within reach.

Body mass index and waist circumference of Latin American adult athletes with intellectual disability

OBJECTIVES

To examine both body mass index (BMI) status and waist circunference (WC) in a large international sample of adult Special Olympics participants from Latin America. It also explored the association of age and sex with obesity in this population.

MATERIALS AND METHODS

BMI and WC records from a total of 4174 (2683 male and 1491 female) participant records from the Special Olympics International Health Promotion database were examined.

RESULTS

The prevalence of overweight and obesity was quite high (i.e. > 40%), but generally lower than studies involving adults with intellectual disabilities from Europe and the USA. Chi-square analyses revealed that both increasing age and being female significantly predicted levels of overweight, obesity, and WC.

CONCLUSIONS

These results suggest that efforts need to be made to prevent and reduce rates of overweight and obesity among Latin American Special Olympics participants, particularly women.

Physical self-concept and body dissatisfaction among Special Olympics athletes: A comparison between sex, weight status, and culture

BACKGROUND

Little research has looked at the associations between sex, weight status and culture, and the physical self-perceptions and body dissatisfaction of individuals with intellectual disabilities (ID) involved in Special Olympics (SO) sports.

AIMS

To examine sex- (male vs female), weight status- (non-overweight/obese vs. overweight/obese), and culture-based (North American vs. Asian) differences in physical self-concept and body dissatisfaction among SO athletes.

METHODS AND PROCEDURES

A total of 139 SO athletes (aged 12-30 years) with ID participated in this study and completed measures of physical self-perceptions and body dissatisfaction. Differences according to sex, weight status, culture, and their interactions were examined.

OUTCOMES AND RESULTS

Males SO athletes presented higher levels of self-perceived physical strength and ideal body shape than females. Additionally, non-overweight/obese SO athletes presented higher levels of self-perceived physical appearance and physical condition than their overweight/obese counterparts, as well as lower actual body shape perceptions and body dissatisfaction. Moreover, North-American SO athletes presented higher levels of self-perceived physical appearance and sport competence than their Asians counterparts, as well as lower actual body shapes perceptions and body dissatisfaction.

CONCLUSION AND IMPLICATIONS

This study reveals substantial sex-, weight status-, and culture-based differences in the physical self-concept and body dissatisfaction of SO athletes.

Maximizing the use of Special Olympics International's Healthy Athletes database: A call to action

There is a critical need for high-quality population-level data related to the health of individuals with intellectual disabilities. For more than 15 years Special Olympics International has been conducting free Healthy Athletes screenings at local, national and international events. The Healthy Athletes database is the largest known international database specifically on the health of people with intellectual disabilities; however, it is relatively under-utilized by the research community. A consensus meeting with two dozen North American researchers, stakeholders, clinicians and policymakers took place in Toronto, Canada. The purpose of the meeting was to: 1) establish the perceived utility of the database, and 2) to identify and prioritize 3-5 specific priorities related to using the Healthy Athletes database to promote the health of individuals with intellectual disabilities. There was unanimous agreement from the meeting participants that this database represents an immense opportunity both from the data already collected, and data that will be collected in the future. The 3 top priorities for the database were deemed to be: 1) establish the representativeness of data collected on Special Olympics athletes compared to the general population with intellectual disabilities, 2) create a scientific advisory group for Special Olympics International, and 3) use the data to improve Special Olympics programs around the world. The Special Olympics Healthy Athletes database includes data not found in any other source and should be used, in partnership with Special Olympics International, by researchers to significantly increase our knowledge and understanding of the health of individuals with intellectual disabilities.

Utilizing health records to characterize obesity, comorbidities, and health-care services in one human service agency in the United States

US surveys report higher prevalence of obesity in adults with intellectual disability. Health records of 40 adults with intellectual disability were retrospectively reviewed for data on health status, problem lists with International Classification of Diseases, Ninth Revision codes, medication lists, and health encounters over 18 months. Mean age was 49.5 years, 53% were males. Prevalence of overweight, obese, and morbidly obese was 28%, 58%, and 23%, respectively. Primary diagnosis was intellectual disability (50% mild, 33% moderate, 10% severe, and 8% profound), 85% had mental health disorders (67.5% with affective or mood and 42.5% had anxiety disorders). On average, residents consumed 2.63 psychotropic medications daily with additional 5.75 medications for axis 3 diagnoses and made 39.2 health visits over past 18 months. Our analysis supports increased prevalence of overweight/obesity, higher comorbidities, dual psychiatric diagnosis, substantial medication consumption, and higher utilization of health-care services in adults with intellectual disabilities. Targeted health interventions are therefore essential to improve their health and quality of life.

Validity of proxy-reported height and weight to derive body mass index in adults participating in Special Olympics

BACKGROUND

Overweight and obesity are common in adults with intellectual disabilities, which complicates their health. To meet their health needs, individuals with intellectual disability frequently rely on proxies to answer questions on their behalf. In the general population, the use of proxy-reported height and weight to compute body mass index (BMI) has been validated, but not among adults with intellectual disability. The objective of this study was to determine the accuracy of proxy-reported height, weight and derived BMI among adults with intellectual disability.

METHODS

Proxies were asked to report height and weight on behalf of adults with intellectual disability who participate in Special Olympics Ontario; their answers were compared to measured height and weight.

RESULTS

Proxies reported height and weight accurately; the sensitivity of proxy reports for classifying individuals with intellectual disability as overweight and/or obese was 84.6%.

CONCLUSION

Proxy reports may be useful when direct measurements of individuals with intellectual disability are not available.

Pregnancy in Women With Intellectual and Developmental Disabilities

OBJECTIVE

Our objectives were to describe the general fertility rate (GFR) and age-specific fertility rates (ASFRs) of women with intellectual and developmental disabilities (IDD) and the social and health characteristics of those with a singleton live birth, and to compare these to women without IDD.

METHODS

In this population-based retrospective cohort study using linked Ontario health and social services administrative data, we identified 18- to 49-year-old women with IDD (N = 21 181) and without IDD (N = 990 776). The GFR and ASFRs (2009) were calculated for both groups and compared using rate ratios (RR) and 95% confidence intervals (CI). Among women with a singleton live birth (N = 423 with, N = 42 439 without IDD), social and health characteristics were compared using Pearson's Chi square tests.

RESULTS

The GFR in women with IDD (20.3 per 1000) was lower than that in women without IDD (43.4 per 1000) (RR 0.47; 95% CI 0.43 to 0.51). ASFRs in 18- to 24-year-olds were similar in both groups. Among women with a singleton live birth, those with IDD were younger and had higher rates of poverty, epilepsy, obesity, and mental health issues. They also had high rates of medication use during pregnancy.

CONCLUSION

In the largest study of fertility in women with IDD to date, we found that ASFRs are similar in young women with and without IDD. Women with IDD with a singleton live birth experience significant social and health disparities during pregnancy. These findings suggest the need to develop services to support the reproductive health of this vulnerable group.

Comparison of obesity among Chinese and U.S. Special Olympic athletes with intellectual disabilities

BACKGROUND/OBJECTIVES

Obesity is a health problem in China, but there are no reports on the obesity status of Chinese citizens with intellectual disabilities (ID). Research has shown that adults with ID have higher body mass index (BMI) than adults without ID, but this information is primarily based on populations residing in North American and European countries. The purpose of this study was to compare BMI and obesity status of Chinese and U.S. Special Olympic athletes with ID.

SUBJECTS/METHODS

Height, weight, BMI and self-reported physical activity (SRPA) data from the Special Olympics 2006 U.S. National Games and 2007 Shanghai World Games databases were analyzed. Linear and logistic analyses were conducted for continuous data and dichotomous variables, respectively. Predictor variables were age, gender, country, SRPA, and obesity status according to country specific criteria. Significance was set at p < 0.05.

RESULTS

The U.S. group had significantly higher BMI values than their Chinese counterparts. Age (p = 0.001) and country (p = <0.001) were the main predictors of BMI and obesity status, even when country-specific standards of obesity classifications were used. Holding all other factors constant, each unit increase of age was associated with increased odds for obesity by a factor of 1.04 and the odds of obesity occurring in U.S. athletes was 2.47 times greater than in Chinese athletes.

CONCLUSION

Obesity is an emerging health problem for Chinese adults with ID. Participation in Special Olympics does not offset obesity in people with ID and other methods of intervention are needed to address obesity in this population segment. This is a global health concern that requires immediate attention.

Disparities in diabetes prevalence and preventable hospitalizations in people with intellectual and developmental disability: a population-based study

AIMS

To describe and compare population-level aspects of diabetes and diabetes primary care among people with and without intellectual and developmental disabilities.

METHODS

Administrative health data accessed from the Institute for Clinical Evaluative Sciences was used to identify a cohort of Ontarians with and without intellectual and developmental disabilities between the ages of 30 and 69 years (n = 28 567). These people were compared with a random sample of people without intellectual and developmental disabilities (n = 2 261 919) according to diabetes prevalence, incidence, age, sex, rurality, neighbourhood income and morbidity. To measure diabetes primary care, we also studied hospitalizations for diabetes-related ambulatory care-sensitive conditions.

RESULTS

Adults with intellectual and developmental disabilities had a consistently higher prevalence and incidence of diabetes than those without intellectual and developmental disabilities. Disparities in prevalence between those with and without intellectual and developmental disabilities were most notable among women, younger adults and those residing in rural or high income neighbourhoods. In terms of hospitalizations for diabetes-related ambulatory care-sensitive conditions, people with intellectual and developmental disabilities were 2.6 times more likely to be hospitalized.

CONCLUSIONS

Adults with intellectual and developmental disabilities are at high risk of developing and being hospitalized for diabetes. The findings of the present study have a number of important implications related to the early detection, prevention and proper management of diabetes among adults with intellectual and developmental disabilities.

Body mass index of children and youth with an intellectual disability by country economic status

OBJECTIVE

Individuals with intellectual disabilities are at higher risk for health disparities including overweight and obesity; however, little is known at the population level about the BMI status of children and youth with intellectual disabilities. This study is a secondary analysis of BMI status (underweight, normal weight, overweight and obese) in children and youth (8-<18years) participating in Special Olympics by country economic status.

METHODS

A total of 14,032 participants (n=8,856 male) measured height and weight records were available from the Special Olympics International Health Promotion database. The 141 countries in the database were re-coded according to the World Bank's classification of country economic status. BMI prevalence rates were calculated for underweight, normal weight, overweight, and obesity for children and youth using IOTF cutoffs by economic status. Chi-squared analyses and Fisher's exact test were used to examine differences in weight status by economy and sex.

FINDINGS

Overall, 27.87% of Special Olympics participants from low-income economies, 31.04% from lower middle-income, 25.29% from upper middle-income, and 42.36% from high-income economies had BMI levels outside of the normal range. The low-income countries had higher rates of underweight and the high-income countries had higher rates of obesity.

CONCLUSIONS

The high levels of both underweight and overweight/obesity found in this population of children and youth participating in Special Olympics represents a double burden of health risk. More research is needed to understand why this population experiences such disparities in BMI status and to develop health promotion initiatives targeted at this population.